Sports injury chat with Dr. Kai Mithoefer

Dr__Kai_Mithoefer: Hi everyone! I'm Dr. Mithoefer from Harvard Vangurd Orthopedics and Sports Medicine. Glad to be here to answer any of your questions on sports injury prevention.

classof2008: hi - is stretching more important before or after working out and playing in a game? thanks!
Dr__Kai_Mithoefer: Stretching is important before and after working out. It makes the muscles and tendons more elastic before the athletic activity and helps to prevent muscle strains. Stetching is also part of the cool down and helps to relax the tight muscles after strenuous workouts and starts the regeneration process.

future_olympian: Doc - what are some particularly good excercises to do to prepare for a full weekend of skiing?
Dr__Kai_Mithoefer: Downhill skiing requires good general conditioning but particularly strength and endurance of the quadriceps, hamstrings, hip flexors. Biking is an excellent exrcise to prepare the lower extremity muscles in general, but you can also use curling machines, leg presses, or squatting exercises. Some fitness clubs offer special ski conditioning classes. Conditioning before skiing is strongly recommended since lack of appropriate fitness is one of the most common causes of ski-related injuries such as ACL tears.

morris: what is the most common sports injury and how can it be easily prevented?
Dr__Kai_Mithoefer: Most sports injuries occur in the knee and ankle, with ankle sprains being the most common. Several studies have shown that ankle sprains can be effectively prevented by a proprioceptive training program which uses a combination of calf muscle strengthening and coordination training on a balance board. Taping or braces can also be used effectively. In case of recurrent ankle sprains the joint should be evaluated by a specialist to rule out instability.

benchwarmer: At what age should a stretching regimen be introduced in a children's soccer practice, and should the stretching be done right at the start or after a warmup activity ?
Dr__Kai_Mithoefer: Stretching should be introduced at an early age in soccer and other sports. Growth spurts in children and adolsecents can result in relative tight and short muscles and tendons that make them more susceptible for muscle and tendon injuries. Developing a thorough pre- and post exercise streching routine is generally recommended at any age.

1st_13_1: I am running my 1st half-marathon. I have never run in the cold weather, which I will have to do until the race in January. What injury prevention advice do you have about muscles in cold and running on ice and snow?
Dr__Kai_Mithoefer: Besides appropriate running gear proper warm up and running program is important. Use warm and protective clothing and frequently change your running shoes (every 300-400 miles). Warming up is critical with warm static stretching after a light 5 minute jog. Stretch after the run and allow for sufficient time for regeneration between your training sessions and crosstrain to not risk overuse injuries.

julie: what do you think of glucosamine to help with knee issues from running?
Dr__Kai_Mithoefer: The literature on glucosamine and chondroitin is inconsistent. In my opinion it can be a useful supplement to maintain joint health and articular cartilage in impact sports like running, particularly since there are few side effects. I would recommend it's use unless specific contraindications exist. If pain exists during running you should not run through it but have it evaluated by your doctor or athletic trainer.

Duke: I had ACL and Miniscus surgery about 3 months ago, and I have to go on a 10 hour flight. What exercises do recommend I do for my knee while sitting in coach?
Dr__Kai_Mithoefer: I encourage you to discuss this question with your treating surgeon, since can evaluate how you have been progressing after your surgery

pbtt: Are school nurses properly prepared for school sports related injuries?
Dr__Kai_Mithoefer: School nurses are certainly a good resource for questions regarding sports-related injuries. Other options are athletic trainers, physical therapists, or physicians associated with the school.

BostonRunner: Lately when I run, my knee has been getting sore. It's not a major pain, but just a little stiff the next day. Someone told me I should do strengthening exercises for it, but where can I find some examples of those?
Dr__Kai_Mithoefer: Running related knee pain can have many causes. Treatment is rest and ice to the knee. Do not run with continued pain. If the pain does not improve, seek medical attention early to avoid chronic and more difficult to treat injuries.

conversationalist: Good afternoon! What is the usual rehab time for a pulled groin? I hurt it mildly last weekend playing softball and I have 4 games this weekend. Should I cancel?
Dr__Kai_Mithoefer: Athletic groin injuries can have different degrees of severity. They often become chronic if not diagnosed and treated appropriately and may require surgery. I strongly recommend early consultation with an athletic trainer, physical therapist, or doctor before any further sports participation.

lefty: Dr. I am a once or twice a week tennis player and have been diagnosed with chronic patellar tendonitis; is this condition curable with PT? Or am I just thinking wishfully by avoiding surgery.
Dr__Kai_Mithoefer: Physical therapy can be very successful. Supervised stretching and strengthening therapy with your therapist should be supplemented with daily home exercises. Modalities such as ultrasound, ice, and iontophoresis can also be helpful. Few patients require surgical treatment, but if you fail a thorough course of PT this can be a successful option.

scoccermom23: Hi Dr. Mithoefer, thakns for being with us today, my son has recently injured his groin, how can he prevent re-injury as he keeps pulling it even when he is not playing sports?
Dr__Kai_Mithoefer: Soccer related groin injuries are best prevented by a throrough core strengthening and flexibility program.

sportsguy73: If I twist my ankle and it gets sore and swollen should I use ice or heat to help it heal faster?
Dr__Kai_Mithoefer: RICE Rest, Ice, Compression bandage, and Elevation are the primary treatment

codi: My son just started playing soccer in a league. How important is it for him to have specialty soccer shoes? Is he more likely to get hurt if he wears regular sneakers?
Dr__Kai_Mithoefer: Appropriate sport-specific shoes are very important. With a pivoting and cutting sport like soccer using cleats is very important to avoid injuries from slipping on natural or artificial turf.

chuckers88: I like to run outside on the pavement, will there be any long term affects on my knees?
Dr__Kai_Mithoefer: Interestingly, the literature shows no clear difference between running on harder or softer surfaces for the development of injuries. Proper conditioning and equipment (running shoes) are more relevant.
Dr__Kai_Mithoefer: Thanks everyone for your interesting questions. If you have any more questions feel free to contact mee at www.harvardvanguard.org